State Cites Overcharges

For Medical Procedures

April 5, 1994|By DIANE HIRTH Tallahassee Bureau

TALLAHASSEE — Floridians were overcharged at least $400 million over the past two years for common medical procedures such as lab tests, diagnostic imaging scans or physical therapy, state health officials said on Monday.

The highest prices came in Broward County, with Dade and Palm Beach close behind.

People sometimes paid double or triple fees that were capped by the state in 1992. For example, a diagnostic scan of a person's lower body typically cost $1,325 in Broward - $780 above the allowable charge.

The money could be rebated directly to consumers and insurers who paid for these procedures since July 1992.

But before imagining how they might spend that rebate, consumers should realize politics are at work here.

The figures were released by the governor's Florida Agency for Health Care Adminstration. They are being used by Gov. Lawton Chiles to pressure the medical community into accepting his proposed health reforms, which are languishing in the Legislature.

Chiles is the one who would decide whether to seek refunds and to pursue hundreds of millions in civil fines. More than 3,000 free-standing medical clinics could have to come up with money owed.

Chiles, however, may agree to scrap the state's limits on medical fees if he gets what he wants out of the Legislature.

Chiles hopes to subsidize health insurance for every low-income Floridian but has been frustrated by physicians who insist that every patient be given full choice of doctors at no extra cost. That concept would kill some of the savings that make Chiles' proposal workable without tax increases.

Republican legislators who support the doctors - and who have found other reasons to attack the plan - could kill Chiles' health reforms in the Senate.

Clearly, the fee caps are being used as a cudgel to convince the medical community that their worst fears - state-set prices - could become a growing phenomenon. National studies consistently show Florida as one of the costliest health care markets in the country.

"I don't think the physicians of Florida should compromise on behalf of choice for their patients," said Gerry Soud, Florida Medical Association spokesman. "This is just politics."

The inflated profits were considerable for owners of free-standing clinics who did lab tests, diagnostic imaging, radiation therapy, physical therapy or rehabilitation services, the agency said.

They were the centers affected by fee caps imposed by the Legislature in 1992 and only recently reaffirmed by a federal appeals court. The charges were not supposed to exceed 115 percent of the approved Medicare fee for such services (125 percent for radiation therapy).

Enforcement of the caps had been in limbo because of federal and state court challenges.

In February, the 11th Circuit Court of Appeals in Atlanta ruled that the caps did not unfairly single out these centers. Doctors' offices and hospitals were exempted from the caps.